The U.S. Department of Health and Human Services has given
conditional approval to 18 states to run their own Small-Business
Health Options Programs (SHOPs) and to another 17 to run their
own insurance exchanges for individuals. While progress has been
made, "many activities remain to be completed and some were
behind schedule," the report says.

"This GAO report confirms our suspicions about the implementation
of the health-care law," said House Small Business Committee
Chairman Sam Graves (R, Mo.) in a statement. "The law is indeed a
train wreck with no relief in sight."

The insurance exchanges are behind schedule in areas including
enrollment, plan management and consumer assistance. In
particular, the program to educate small-business owners and
their employees and help them enroll in the health-insurance
exchanges is approximately two months behind the deadlines the
U.S. Centers for Medicare and Medicaid Services laid out, the
report says. Of the tasks expected to be completed by March 31,
44 percent were behind schedule, the report says. The report
notes that CMS says it has been changing its target deadlines and
so certain delays may not affect the implementation of the
exchanges.

The U.S. Department of Health and Human Services spokeswoman
Joanne Peters says it will meet health-insurance exchange
deadlines. "We have already met key milestones and are on track
to open the Marketplace on time," Peters says in an email. For
example, it has published a streamlined application for the
exchanges and is in the final stages of testing the technological
infrastructure necessary to support the enrollment process.

This is not the first delay for the health-insurance exchanges.
In April, the Obama Administration requested that states be given
more time to set up multiple options for health-insurance
coverage, effectively pushing deadlines back by one year. In
2014, states would be required to have only a single health-insurance option ready on the
SHOPs.

The health-care overhaul passed by President Obama three years
ago requires that each state which elects to operate its own
health exchange must also offer a SHOP. An exchange is a
marketplace where, eventually, individuals and business owners
will be able to compare, select and purchase health insurance.
The SHOPs are where small-business owners specifically can find
insurance options for their employees. Should a state decline the
option to run its own health-insurance exchange, the U.S. would
step in and establish the exchange in that state.